The unevenness of cataract surgery

 
Cataract surgery, once only for elderly patients, is now increasingly being performed on younger baby boomers.
 
Facts
More than half of the over-65s suffer from cataracts, which are cloudy patches in the lens that make vision blurred or misty. The condition is linked to smoking, poor diet or health conditions such as diabetes.
 
Cataracts can affect your ability to read, write, watch TV, work at a computer, and drive. Severe cases can affect your ability to wash, dress, cook and work.
 
According to the World Health Organization (WHO), 285 million people worldwide are visually impaired, 90% of these live in developing countries where cataracts are the leading cause of blindness. 
Generational differences in rich countries
Baby boomers who have cataract operations are significantly different to previous generations who were more complacent, expected less and typically accepted that with age comes loss of opportunity and function.
 
Baby boomers are part of a 'fix-it' culture. They seek-out solutions rather than passively hope for them. When they sense a limitation they fix-it with such things as artificial joints, Botox, Restylane, Viagra, anti aging cream and increasingly, cataract surgery: now the most commonly performed surgical procedure in the world.
 
The reasons are clear. Baby boomers have disposable income, they are more active, working longer and have greater demands on their vision. Also, they're more likely to have taken advantage of surgery to address myopia, hyperopia, astigmatism and even presbyopia, and they know the excellent results they can get.
Treatment
Currently, the only treatment for cataracts is surgery. According to the WHO, in 2010, 19 million cataract procedures were performed and by 2020, this number is projected to increase to 32 million per year.
 
The overwhelming majority of these procedures are performed in developed countries. Currently, in the US, 1.5 million cataract extractions are performed annually, and in the UK about 0.4 million. 
Traditional cataract surgery
Two decades ago, cataract surgery meant a three-day hospital stay, patients couldn’t move around and it took a while for them to get their vision back.
 
Traditional cataract surgery requires the use of a hand-held blade to make multiplanar incisions in the cornea to access the cataract. A surgical instrument is then used to manually create an opening in the lens capsule that holds the cataract. The goal is to make the corneal incisions precise; make the opening in the lens capsule as circular as possible, in the right location and sized to fit the replacement lens.
 
Technical breakthroughs
Technical breakthroughs mean that now a 45-minute bladeless, laser procedure is positioned to revolutionise cataract surgery.
 
"In the 1980s phacoemulsification significantly changed cataract surgery and reduced admission times and complication rates. In 2001, femtosecond laser technology was introduced clinically for ophthalmic surgery as a new technique for creating lamellar flaps in laser in situ keratomileusis (LASIK). In 2010 femtolaser was developed into a new tool for cataract surgery; although it is not generally accepted yet the technique is developing and is likely to become the gold standard in time," says Mr. Hugo Henderson, Consultant Ophthalmologist and Ocuplastic Surgeon, Royal Free Hospital, London.
 
Cataracts in poorer countries
While baby boomers in rich countries can stave off the debilitating effects of cataracts with a 45-minute procedure, in poor countries cataracts remain the world's leading cause of blindness. 
 
Blindness is particularly devastating in the developing world where it has a profound impact on the quality of life for the blind person and his or her community. Life expectancy of the blind is usually less than half that of someone with eyesight the same age.

The desperateness of this situation is augmented by the fact that a blind person is unable to contribute to the family income. Not only does blindness mean a father is unable to work, or a mother cannot collect water or go to market, but someone with eyesight must care for him or her. Effectively two income-producing individuals are lost. This creates a devastating economic impact on the family and the community.

In the developing world, cataract surgery is available for only a small proportion of those in need. This is partly because of low demand - caused by barriers related to awareness, bad services, cost, and distance - and partly because of deficiencies in the supply of services. 
 
Takeaways
The annual global economic impact of blindness and poor vision caused by lost economic productivity is immense and affects everyone.
 
Eighty per cent of all visual impairment can be avoided or cured.
 

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